Medieval Plague Doctors: Masked saviours or grim harbingers of impending death?

The advent of the Plague Doctor is deeply intertwined with the history of the Black Death, one of the deadliest pandemics in human history.

The disease first struck Europe in 1347, arriving on merchant ships infested with plague-ridden rats.

Within a span of five years, it decimated between 30% to 60% of Europe's population.

The scale of the catastrophe was so immense that it necessitated the creation of a specialized role to combat it: the Plague Doctor.

They were hired by towns and cities, especially in later outbreaks in the 16th and 17th centuries, and their primary duty was to treat and care for plague victims, irrespective of their social status.

These doctors were also tasked with recording deaths in public records, a grim statistic that helped authorities gauge the severity of an outbreak.

One of the earliest surviving contracts for a plague doctor dates to 1348 in the city of Perugia, where authorities hired physicians to treat the sick.

When university-educated physicians refused to enter infected areas, unfortunately the cities hired whoever was willing.

Early Plague Doctors were often second-rate doctors or surgeons unable to establish a successful practice, medical students still in training, or even individuals with no professional medical background.

Plague doctors were often paid fixed salaries by municipal governments, with contracts sometimes offering housing, food, and immunity from prosecution for accidental death during treatment.

In later centuries, one of the most distinctive aspects of the Plague Doctor was their unique costume, which has since become an iconic symbol of the Black Death.

The costume was not merely for show; it was intended to protect the doctors from the deadly disease they were fighting.

It was first described by Charles de Lorme, a prominent physician of the 17th century who is often credited with its invention.

According to de Lorme, the outfit was "made of Moroccan leather," and was designed to cover the doctor's entire body, shielding them from potential infection.

The most recognizable feature of the Plague Doctor's costume was the mask, which had a beak-like shape.

This 'beak' served a practical purpose. It was filled with aromatic substances and straw, which were believed to purify the air the doctor breathed.

The costume also included a wide-brimmed hat, which indicated the doctor's profession, and a long, waxed overcoat.

The overcoat, along with leather breeches, gloves, and boots, created a barrier between the doctor and the outside world.

To further protect themselves, doctors often carried a wooden cane, which they used to examine patients without making physical contact.

Despite its practical intentions, the costume was far from perfect. The understanding of disease transmission was rudimentary at best during the Middle Ages, and the costume provided limited protection.

However, it did offer some psychological comfort to the doctors and made them easily recognisable by the public.

The medical practices and treatments employed by Plague Doctors were a reflection of the medical understanding of the time, which was unfortunately quite limited.

The germ theory of disease, which underpins modern medicine, would not be developed until centuries later.

Instead, the prevailing theory was that of miasma, or "bad air," which was believed to be the cause of the plague and many other diseases.

Plague Doctors were known to use a variety of treatments, many of which would be considered bizarre or even harmful by today's standards.

Bloodletting, for instance, was a common practice. This involved cutting open a patient's vein and allowing them to bleed, with the belief that this would balance the "humors" in the body - blood, phlegm, black bile, and yellow bile - and thus restore health.

Another common treatment was the use of "plague water," a concoction of various herbs and occasionally including crushed emeralds or gold.

This was either drunk by the patient or applied to their buboes - the painful swellings characteristic of the plague.

The effectiveness of these treatments was, at best, questionable, and at worst, detrimental.

In addition to these treatments, some Plague Doctors were also responsible for issuing health advice to the public.

This could include recommendations for maintaining personal hygiene, cleaning homes, and avoiding crowded places.

They also advised on dietary habits, suggesting foods that were believed to strengthen the body against the plague.

As the Black Death swept across Europe, decimating entire communities, Plague Doctors became a common sight, a stark reminder of the suffering at the time.

For some, Plague Doctors were seen as figures of hope. They were often the only ones willing to treat the afflicted, venturing into areas where even priests feared to tread.

For those who were sick, the arrival of a Plague Doctor could give them hope of surviving, and for the healthy, their presence was a reassurance that efforts were being made to combat the plague.

On the other hand, Plague Doctors also brought about fear and dread. Their distinctive costumes, designed for protection, were alien and intimidating, adding to the overall sense of unease and terror.

Moreover, given the high mortality rate of the plague and the limited effectiveness of treatments, the appearance of a Plague Doctor often signaled impending death, leading to their association with the grim reaper.

The public perception of Plague Doctors was further complicated by their social status.

Many Plague Doctors were not fully qualified physicians, but rather individuals who had taken up the role out of necessity or opportunity.

This, coupled with their high fees and the general ineffectiveness of their treatments, often led to suspicion and resentment.

While many Plague Doctors remain anonymous figures lost to history, a few stand out for their contributions to medicine and their impact on society during the time of the plague.

Perhaps the most famous Plague Doctor is Nostradamus, known primarily for his prophecies.

Born Michel de Nostredame in 1503, Nostradamus was a physician before he became famous for his predictions.

He worked during the outbreak of the plague in Provence in the 1540s. Unlike many of his contemporaries, Nostradamus favored hygiene and cleanliness in treating patients, practices that were not widely accepted at the time but are now recognized as crucial in disease prevention.

Guy de Chauliac was a preeminent French physician and surgeon who was personal doctor to three popes. During the Black Death outbreak of 1348-1350, he remained in Avignon, courageously treating plague victims.

He even contracted the disease himself but survived and his experience informed his later writings. 

Another notable Plague Doctor was Giovanni de Ventura of Parma, an Italian physician who treated plague patients in the late 16th century.

He was one of the first doctors to perform autopsies on plague victims, a practice that was controversial at the time but contributed significantly to the understanding of the disease.

Charles de Lorme is another significant figure in the history of Plague Doctors. As well as being credited with designing the iconic Plague Doctors costume, he was a physician to several French kings.

His contributions to the field, particularly his emphasis on protective clothing for physicians, took a significant step forward in the history of medical safety.

The era of the Plague Doctor came to an end as the frequency and severity of plague outbreaks diminished over time.

The last major outbreak in Europe, the Great Plague of Marseille, occurred in 1720, although smaller outbreaks continued into the 18th century.

As the threat of the plague receded, the need for specialized Plague Doctors gradually diminished.

The decline of the Plague Doctor was also tied to advancements in medical science.

The 19th century saw significant strides in understanding disease and the human body.

The miasma theory, which had been the basis for much of the Plague Doctor's work, was gradually replaced by the germ theory of disease, which posited that specific microorganisms, not "bad air," were responsible for illness.

This shift in understanding led to more effective treatments and preventive measures, further reducing the need for Plague Doctors.

Moreover, the medical profession itself underwent a transformation. The practice of medicine became more regulated, and standards for medical education and practice were established.

This led to a decline in the number of unqualified or minimally qualified individuals acting as doctors, including Plague Doctors.